Our recovery approach
Our recovery approach requires a different relationship between service users and professionals; one where openness, trust and honesty is critical to building effective relationships.
Roberts & Wolfson (2004) have characterised this approach as a shift from staff who are seen as remote, in a position of expertise and 'authority', to someone who behaves more like a personal coach or trainer.
SIL’s support model is designed to empower people and to challenge and break the dependencies and expectations that can result from more traditional delivery models. We believe that with the right support, people with mental ill health can recover; that this capacity is inherent to the individual and that our role is to support them to discover the strengths they have to break away from the role and identity of 'patient'.
At SIL we really believe that with the right type of support, people can ‘recover’ and lead more fulfilling and productive lives. With this belief at our core, we have moved away from the more traditional model of hourly based support, focussing instead on ensuring that our services are staffed by well-trained, knowledgeable and experienced staff who are able to flex support around individuals. This allows them to 'step up' when greater support is needed, but also 'step back' and deliver just the right level of support to ensure that unnecessary dependencies are not created. They also take care to use a coaching-style approach so that opportunities for self-development are not lost.
SIL’s scheme fee model
Most funding for mental health community placements is based on the commissioning of a set number of hours in support of a planned intervention. We believe that there is still a need for this type of approach to funding when considering how to support someone maintaining their independence who has progressed to a higher degree of self-management. However, it is the route to achieving a higher degree of self-management and self-determination that requires a more creative approach to funding that supports the process or journey an individual must take to achieve their goals.
It is also true that the nature of supporting someone with a mental illness often requires the management of risk and hence involving unpredictability, fluctuation, and rapid change, with some mental illnesses operating in cycles of relapse and recovery.
To be able to deliver support which facilitates the recovery process it is therefore necessary to have staff available and accessible throughout the day. This is not to say that the staff will be continually engaging in planned activity with a client throughout the day, but rather to ensure that there is sufficient skill and knowledge to support and guide each individual as and when they require. It is equally important not to be overly prescriptive about the timing of planned support, for example, it may be more productive to delay a discussion or key-work session by a few hours following a difficult therapy session.
To ensure that SIL is able to provide transparency around its fee structure and evidence a clear plan and purpose for each individual placement, we have developed our own fee banding tool. This tool links directly to each individual’s pre-admission assessment and provides both the background to an area of need as well as a broad intervention plan.
The pre-admission assessment is used to gather a current and historical context measured against 11 recovery outcome areas. This is achieved through a comprehensive review of all the background reports, discussion with the current care team and relevant clinicians as well as meeting directly with the client themselves. Our pre-admission assessment process is managed by our Quality and Practice Team and ensures that we draw from a broad range of experienced and qualified mental health practitioners that includes Social Workers, AMHP’s, Occupational Therapists and Registered Mental Health Nurses.